Author
Jennifer Drothy Rafacz
Other affiliations: Northwestern University
Bio: Jennifer Drothy Rafacz is an academic researcher from Illinois Institute of Technology. The author has contributed to research in topics: Mental illness & Stigma (botany). The author has an hindex of 5, co-authored 5 publications receiving 1556 citations. Previous affiliations of Jennifer Drothy Rafacz include Northwestern University.
Papers
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TL;DR: A meta-analysis that examined the effects of antistigma approaches that included protest or social activism, education of the public, and contact with persons with mental illness found both education and contact had positive effects on reducing stigma for adults and adolescents with a mental illness.
Abstract: Stigma associated with mental illness has malignant effects on the lives of people with serious mental illnesses. Many strategies have been used to combat public stigma—the prejudice and discrimination endorsed by the general population. To identify the most effective approaches, researchers conducted a meta-analysis of data from 72 outcome studies in 14 countries. Overall, strategies that include education about mental illness and contact with people who have mental illness are effective. For adults, contact appears to be more effective, whereas education seems to work best among adolescents.
1,239 citations
TL;DR: The model was tested on 85 people with schizophrenia or other serious mental illnesses who completed measures representing the four stages of self-stigma, another independently-developed instrument representing self-Stigma, proxies of harm (lowered self-esteem and hopelessness), and depression and results were mixed.
Abstract: The self-esteem of some people with serious psychiatric disorders may be hurt by internalizing stereotypes about mental illness. A progressive model of self-stigma yields four stages leading to diminished self-esteem and hope: being aware of associated stereotypes, agreeing with them, applying the stereotypes to one's self, and suffering lower self-esteem. We expect to find associations between proximal stages - awareness and agreement - to be greater than between more distal stages: awareness and harm. The model was tested on 85 people with schizophrenia or other serious mental illnesses who completed measures representing the four stages of self-stigma, another independently-developed instrument representing self-stigma, proxies of harm (lowered self-esteem and hopelessness), and depression. These measures were also repeated at 6-month follow-up. Results were mixed but some evidence supported the progressive nature of self-stigma. Most importantly, separate stages of the progressive model were significantly associated with lowered self-esteem and hope. Implications of the model for stigma change are discussed.
307 citations
TL;DR: This study compares coming out to other approaches of controlling self-stigma, finding benefits of being out was associated with affirming strategies and becoming aloof, not with strategies of shame, and implications for how coming out enhances the person's quality of life are discussed.
Abstract: Self-stigma can undermine self-esteem and self-efficacy of people with serious mental illness. Coming out may be one way of handling self-stigma and it was expected that coming out would mediate the effects of self-stigma on quality of life. This study compares coming out to other approaches of controlling self-stigma. Eighty-five people with serious mental illness completed measures of coming out (called the Coming Out with Mental Illness Scale, COMIS), self-stigma, quality of life, and strategies for managing self-stigma. An exploratory factor analysis of the COMIS uncovered two constructs: benefits of being out (BBO) and reasons for staying in. A mediational analysis showed BBO diminished self-stigma effects on quality of life. A factor analysis of measures of managing self-stigma yielded three factors. Benefits of being out was associated with two of these: affirming strategies and becoming aloof, not with strategies of shame. Implications for how coming out enhances the person's quality of life are discussed.
201 citations
TL;DR: Findings suggest the 30 min version of IOOV is as effective as the 90 min standard, and possibly even more so, than the 90- versus 30-min version.
Abstract: In Our Own Voice (IOOV) is a 90-min anti-stigma program that comprises face-to-face stories of challenges of mental illness and hopes and dreams commensurate with recovery. We pared down IOOV to a 30-min version, using information from two focus groups. In this study, effects of 90- versus 30-min IOOV are contrasted with 30 min of education. Two hundred research participants were randomly assigned to one of these three conditions and completed a measure of stigmatizing perceptions and recollections. People in the education group remembered more negatives than the two IOOV groups. To control for overall response rate, a difference ratio was determined (difference in positive and negative recollection divided by overall recollections). Results showed the two IOOV conditions had significantly better ratios than education. These findings suggest the 30 min version of IOOV is as effective as the 90 min standard.
57 citations
TL;DR: This study completed semi-structured interviews with 13 gay men and lesbians in order to better understand the personally perceived consequences that guide the coming out process and postulated how these consequences might manifest themselves in the disclosure process of people with serious mental illnesses.
Abstract: Goffman (Stigma: Notes on the management of spoiled identity, Prentice-Hall Inc., Englewood Cliffs, NH, 1963) distinguished stigmatized groups as discredited (with relatively obvious marks such as people of color or gender) or discreditable (without obvious marks, causing stigma to be largely hidden). Like gay men and lesbians, people with various mental illnesses can opt to stay in the closet about these conditions in order to avoid corresponding prejudice and discrimination. In this study, we completed semi-structured interviews with 13 gay men and lesbians in order to better understand the personally perceived consequences that guide the coming out process. This information would, in turn, help us to better comprehend the process of coming out for people with mental illnesses. Interview participants identified specific benefits and costs. Benefits that promote disclosure include acceptance, community, and comfort and happiness. Costs that diminish coming out decisions include shame and conformity as well as harm and discrimination. We then postulated how these consequences might manifest themselves in the disclosure process of people with serious mental illnesses. Finally, implications for stigma management and change were considered.
51 citations
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TL;DR: The complex elements of stigma are reviewed in order to understand its impact on participating in care and public policy considerations in seeking to tackle stigma in orderto improve treatment engagement are summarized.
Abstract: Treatments have been developed and tested to successfully reduce the symptoms and disabilities of many mental illnesses. Unfortunately, people distressed by these illnesses often do not seek out services or choose to fully engage in them. One factor that impedes care seeking and undermines the service system is mental illness stigma. In this article, we review the complex elements of stigma in order to understand its impact on participating in care. We then summarize public policy considerations in seeking to tackle stigma in order to improve treatment engagement. Stigma is a complex construct that includes public, self, and structural components. It directly affects people with mental illness, as well as their support system, provider network, and community resources. The effects of stigma are moderated by knowledge of mental illness and cultural relevance. Understanding stigma is central to reducing its negative impact on care seeking and treatment engagement. Separate strategies have evolved for counteracting the effects of public, self, and structural stigma. Programs for mental health providers may be especially fruitful for promoting care engagement. Mental health literacy, cultural competence, and family engagement campaigns also mitigate stigma's adverse impact on care seeking. Policy change is essential to overcome the structural stigma that undermines government agendas meant to promote mental health care. Implications for expanding the research program on the connection between stigma and care seeking are discussed.
938 citations
TL;DR: It is argued that a key to challenging self-stigma is to promote personal empowerment, and individual- and societal-level methods for reducing self-Stigma, programs led by peers as well as those led by social service providers are discussed.
Abstract: People with mental illness have long experienced prejudice and discrimination. Researchers have been able to study this phenomenon as stigma and have begun to examine ways of reducing this stigma. Public stigma is the most prominent form observed and studied, as it represents the prejudice and discrimination directed at a group by the larger population. Self-stigma occurs when people internalize these public attitudes and suffer numerous negative consequences as a result. In our article, we more fully define the concept of self-stigma and describe the negative consequences of self-stigma for people with mental illness. We also examine the advantages and disadvantages of disclosure in reducing the impact of stigma. In addition, we argue that a key to challenging self-stigma is to promote personal empowerment. Lastly, we discuss individual- and societal-level methods for reducing self-stigma, programs led by peers as well as those led by social service providers.
701 citations
TL;DR: It is found that social contact is the most effective type of intervention to improve stigma-related knowledge and attitudes in the short term, however, the evidence for longer-term benefit of such social contact to reduce stigma is weak.
650 citations
TL;DR: A conceptual model is proposed to illustrate how online peer-to-peer connections may afford opportunities for individuals with serious mental illness to challenge stigma, increase consumer activation and access online interventions for mental and physical wellbeing.
Abstract: Aims: People with serious mental illness are increasingly turning to popular social media, including Facebook, Twitter or YouTube, to share their illness experiences or seek advice from others with similar health conditions. This emerging form of unsolicited communication among self-forming online communities of patients and individuals with diverse health concerns is referred to as peer-to-peer support. We offer a perspective on how online peer-to-peer connections among people with serious mental illness could advance efforts to promote mental and physical wellbeing in this group. Methods: In this commentary, we take the perspective that when an individual with serious mental illness decides to connect with similar others online it represents a critical point in their illness experience. We propose a conceptual model to illustrate how online peer-to-peer connections may afford opportunities for individuals with serious mental illness to challenge stigma, increase consumer activation and access online interventions for mental and physical wellbeing. Results: People with serious mental illness report benefits from interacting with peers online from greater social connectedness, feelings of group belonging and by sharing personal stories and strategies for coping with day-to-day challenges of living with a mental illness. Within online communities, individuals with serious mental illness could challenge stigma through personal empowerment and providing hope. By learning from peers online, these individuals may gain insight about important health care decisions, which could promote mental health care seeking behaviours. These individuals could also access interventions for mental and physical wellbeing delivered through social media that could incorporate mutual support between peers, help promote treatment engagement and reach a wider demographic. Unforeseen risks may include exposure to misleading information, facing hostile or derogatory comments from others, or feeling more uncertain about one's health condition. However, given the evidence to date, the benefits of online peer-to-peer support appear to outweigh the potential risks. Conclusion: Future research must explore these opportunities to support and empower people with serious mental illness through online peer networks while carefully considering potential risks that may arise from online peer-to-peer interactions. Efforts will also need to address methodological challenges in the form of evaluating interventions delivered through social media and collecting objective mental and physical health outcome measures online. A key challenge will be to determine whether skills learned from peers in online networks translate into tangible and meaningful improvements in recovery, employment, or mental and physical wellbeing in the offline world.
627 citations
TL;DR: A range of interventions demonstrate promise for achieving meaningful improvements in stigma related to substance use disorders and the limited evidence indicates that self-stigma can be reduced through therapeutic interventions such as group-based acceptance and commitment therapy.
Abstract: Aims This study provides a systematic review of existing research that has empirically evaluated interventions designed to reduce stigma related to substance use disorders. Methods A comprehensive review of electronic databases was conducted to identify evaluations of substance use disorder related stigma interventions. Studies that met inclusion criteria were synthesized and assessed using systematic review methods. Results Thirteen studies met the inclusion criteria. The methodological quality of the studies was moderately strong. Interventions of three studies (23%) focused on people with substance use disorders (self-stigma), three studies (23%) targeted the general public (social stigma) and seven studies (54%) focused on medical students and other professional groups (structural stigma). Nine interventions (69%) used approaches that included education and/or direct contact with people who have substance use disorders. All but one study indicated their interventions produced positive effects on at least one stigma outcome measure. None of the interventions have been evaluated across different settings or populations. Conclusions Arangeof interventionsdemonstratepromiseforachievingmeaningfulimprovementsinstigmarelated to substance use disorders. The limited evidence indicates that self-stigma can be reduced through therapeutic interventions such as group-based acceptance and commitment therapy. Effective strategies for addressing social stigma include motivational interviewing and communicating positive stories of people with substance use disorders. For changing stigma at a structural level, contact-based training and education programs targeting medical students and professionals (e.g. police, counsellors) are effective. add_3601 39..50
618 citations